Cenesthopathic schizophrenia, also known as cenesthetic schizophrenia, is a subtype of schizophrenia characterized by prominent disturbances in bodily sensation. Patients with cenesthopathic schizophrenia experience bizarre and disturbing sensations within their own bodies, often complaining of unusual feelings under the skin or within their flesh and organs.
What are the symptoms of cenesthopathic schizophrenia?
The main symptoms of cenesthopathic schizophrenia include:
- Cenesthesias – Unusual and unpleasant sensations within the body such as tingling, burning, electrical currents, pain, movement, twitching, itching etc.
- Somatic hallucinations – False sensations of things happening inside the body such as feeling one’s organs rotting or insects crawling under the skin.
- Somatic delusions – Fixed, false beliefs about the body such as believing one’s flesh is infested with parasites or dead.
- Body image disturbances – Altered experiences of one’s body shape, size or internal structure.
- Derealization – Feeling detached from one’s body or feeling that parts of one’s body don’t belong.
Along with these cenesthetic disturbances, patients may also experience:
- Cognitive deficits
- Disorganized speech and behavior
- Loss of motivation
- Social withdrawal
- Depression and anxiety
What causes cenesthopathic schizophrenia?
The exact causes of cenesthopathic schizophrenia are unknown, but likely involve a complex interplay between genetic, neurological and environmental factors including:
- Genetics – Having a family history of schizophrenia increases risk. Certain gene variants affect brain development.
- Brain chemistry – Imbalances in neurotransmitters like dopamine and glutamate may play a role.
- Brain structure – Abnormalities in regions involved in processing bodily sensations.
- Stress – High levels of stress may contribute to onset or worsen symptoms.
- Drug use – Use of certain drugs like marijuana or amphetamines may increase risk.
Abnormal functioning in networks between sensory areas of the brain and regions involved in bodily representation and self-awareness are believed to underlie the distorted body sensations in cenesthopathic schizophrenia.
Who gets cenesthopathic schizophrenia?
Cenesthopathic schizophrenia accounts for around 10% of schizophrenia cases. It affects men and women equally, with onset typically occurring in late adolescence or early adulthood between the ages of 15-35.
Risk factors include:
- Family history of psychosis
- Obstetric complications
- Childhood trauma or abuse
- Urban upbringing
- Immigration/minority status
- Substance abuse
How is cenesthopathic schizophrenia diagnosed?
There are no specific laboratory or imaging tests to diagnose cenesthopathic schizophrenia. Diagnosis is made based on the person’s reported symptoms, psychiatric evaluation, medical history and observations of the individual’s behavior.
Key diagnostic criteria include:
- Prominent bodily hallucinations or delusions lasting at least one month.
- Disturbances in behavior, speech and thinking that impair functioning.
- Signs and symptoms persisting for at least six months.
- Impaired occupational or social functioning.
- Mood symptoms excluded as primary cause.
- Substance use excluded as primary cause.
- No other medical condition or mental disorder better explains the symptoms.
Other disorders like dementia, epilepsy, brain tumors, drug effects or body dysmorphic disorder may have similar symptoms and need to be excluded.
How is cenesthopathic schizophrenia treated?
Treatment involves a combination of antipsychotic medications, psychotherapy, and psychosocial interventions:
Medications
- Antipsychotics like haloperidol, risperidone, olanzapine etc. to reduce psychotic symptoms.
- Antidepressants or mood stabilizers for mood symptoms.
- Anti-anxiety medications as needed for anxiety.
Psychotherapy
- Cognitive behavioral therapy to modify thinking patterns.
- Coping skill training for daily functioning.
- Family therapy to educate and support family members.
Other Interventions
- Psychoeducation to teach about the disorder.
- Social skills training to improve communication.
- Supported employment to assist with workplace accommodations.
- Peer support groups to reduce isolation.
Treatment is focused on relieving symptoms, improving quality of life and helping the individual maintain social and occupational functioning. Support from family and community is also beneficial.
What is the prognosis for cenesthopathic schizophrenia?
With appropriate treatment and support, many people with cenesthopathic schizophrenia can achieve remission of symptoms and good psychosocial functioning. However, cenesthopathic schizophrenia is often considered to have a poorer prognosis than other subtypes of schizophrenia.
Factors indicating better prognosis include:
- Good premorbid functioning and social support
- Sudden onset of symptoms
- No mood or substance use disorders
- Mainly positive symptoms like hallucinations
- Good response to antipsychotic treatment
Poorer prognosis is associated with:
- Poor functioning before onset
- Insidious onset of symptoms
- Mainly negative symptoms like apathy, social withdrawal
- Cognitive impairment
- Treatment resistance
- Persistent somatic delusions
- Co-occurring substance abuse
Even with treatment, residual or recurrent symptoms are common. Sufferers may have persistent disability requiring long-term support. Suicide risk is elevated.
What is the history of cenesthopathic schizophrenia?
Descriptions of body-centered hallucinations and delusions trace back to antiquity in the writings of Aretaeus of Cappadocia. In the 1800s, French psychiatrists introduced the term “cenesthopathie” to describe bodily hallucinations.
The subtype “cenesthetic schizophrenia” was first coined in Germany in the early 1900s. In 1911, German psychiatrist Karl Bonhoeffer systematically described cenesthopathic schizophrenia as a distinct clinical entity characterized by disturbing bodily sensations.
The concept of cenesthopathic schizophrenia was elaborated on through the 20th century. Research continues to investigate the neurobiology underlying bodily disturbances in psychosis.
Today, cenesthopathic schizophrenia remains an established diagnostic category in classificatory systems like DSM-5 and ICD-10. However, views vary on whether it should be conceptualized as a distinct subtype or dimension of schizophrenia.
What are some examples of somatic symptoms reported in cenesthopathic schizophrenia?
Patients with cenesthopathic schizophrenia describe a diverse range of bizarre somatic complaints and experiences. Some examples include:
Cenesthesias:
- Burning sensations under the skin or within the body
- Feeling of ants crawling under or on the skin (formication)
- Feelings of electrical currents or shocks in the body
- Numbness, tingling or loss of sensation in parts of the body
- Itching, tickling, or pinprick sensations on or within the body
- Feeling body parts shrinking, growing, distorting or changing shape
Somatic hallucinations:
- Hearing voices or sounds coming from inside the body
- Feeling something moving inside body cavities or organs
- Feeling insects crawling or living inside one’s flesh
- Feeling one’s organs being removed or destroyed
- Hearing one’s thoughts echoed inside the body
Somatic delusions:
- Believing parasites have infested the skin or body
- Belief that body parts are diseased, dead, rotting or missing
- Belief that inner organs have stopped functioning or are malfunctioning
- Belief that body processes like digestion, respiration have changed or ceased
- Belief that the body is emitting strange odors or substances
Body image disturbances:
- Feeling detached from one’s body or parts of one’s body
- Feeling larger or smaller than actual size
- Distorted sense of shape, symmetry or anatomy of the body
- Disconnectedness between bodily sensation and physical body
- Feeling like parts of one’s body don’t belong to the self
Conclusion
In summary, cenesthopathic schizophrenia is a subtype of schizophrenia involving abnormal bodily sensations, hallucinations and delusions. It is believed to arise from dysfunctional brain circuits linking sensory processing, bodily representations and the sense of self. While often considered to have a poorer prognosis than other schizophrenia subtypes, many patients respond well to treatment and psychosocial support. Better understanding the neurobiology of bodily distortions in psychosis may lead to improved treatment approaches in the future.